Hospital discharge delays gradually reducing

Delayed discharges from hospitals in Lancashire are reducing - but still missing targets.
Delayed discharges from hospitals in Lancashire are reducing - but still missing targets.
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The number of patients stuck in hospitals across Lancashire when they are medically fit to leave is reducing.

But a meeting of health and social care representatives heard the county is still “miles off” the targets which it has been set.

There were more than 51,000 delayed discharges during 2017/18, representing every day which patients spent in hospital unnecessarily - that was 24 percent higher than the level demanded by NHS bosses. But the numbers did fall during the second half of the year.

Gary Hall, Chief Executive of Chorley Council, said the pace of change was always likely to be slow because of the scale of the challenge.

“It seems to me that what we’ve got is a system which can’t be fixed to the extent that everybody expects it to be fixed,” he said. “We’re still miles off those really challenging targets.”

County Cllr Shaun Turner, chair of the Lancashire Health and Wellbeing Board, told the committee he was “genuinely optimistic”, but admitted that some of the targets are “bloody difficult” to hit.

“The path forward isn’t exactly clear of obstacles,” he added.

One obstacle which has been avoided is the loss of targeted government cash to tackle so-called delayed transfers of care (DTOCs).

A joint letter from the Secretaries of State for Health and Communities and Local Government last November, warned Lancashire that money from the Improved Better Care Fund (IBCF) could be clawed back if the county missed its DTOC targets.

But that threat was lifted and papers presented to the committee revealed that the area received the £28m of IBCF money which it was expecting. That formed part of a pot totalling more than £122m allocated to the county under the government’s overall Better Care Fund (BCF).

The split between delays caused by hospitals and the social care sector tipped towards the former as the year drew to a close.

The future of the BCF - designed to better integrate health and social care - is uncertain beyond next year.

Lancashire’s Director of Public Health warned of the risks of becoming reliant on a pot of money which was not necessarily recurrent.

“We will have missed a trick if we look at the BCF as a solution,” Dr. Sakthi Karunanithi said. He told committee members that health and social care budgets across different organisations and parts of the county were going to have to be treated as a single pool.

One of the measures which the BCF has helped to fund is a policy called Home First. That involves discharging patients after initial assessment and carrying out any further assessments within a home setting.

Mark Youlton, Accountable Officer for East Lancashire Clinical Commissioning Group, said up to 60 patients per week were now being dealt with in that way in Pennine Lancashire.